Healthcare Provider Details

I. General information

NPI: 1396206868
Provider Name (Legal Business Name): MATTHEW THOMAS DE RUYTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 W 39TH AVE
KANSAS CITY KS
66103-2943
US

IV. Provider business mailing address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-5000
  • Fax:
Mailing address:
  • Phone: 913-588-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number04-51647
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA194268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: